Prevention Challenges

Epidemiologist Highlights Potential Impact of Contaminated Bronchoscopes on COVID-19 Patients

Infection Control & Hospital Epidemiology, outlines the heightened risks of using reusable bronchoscopes on COVID-19 patients.

As hospitals in the U.S. grapple with rising COVID-19 caseloads and diminishing supplies for treatment and protection, Cori Ofstead, an epidemiologist with 25 years of research experience, is highlighting the urgent need to protect patients from device-related cross-contamination in COVID-19 procedures.

Her latest paper, “Potential impact of contaminated bronchoscopes on novel coronavirus disease (COVID-19) patients,” accepted for publication by Infection Control & Hospital Epidemiology, outlines the heightened risks of using reusable bronchoscopes on COVID-19 patients. It comes as the COVID-19 pandemic has put immense strain on healthcare systems across the globe.

This letter-to-the-editor-style paper addresses the challenges of adequately reprocessing bronchoscopes even in routine times, and points to a greater need for discipline and vigilance when there is “an urgent need to reduce the number of patients requiring hospitalization or intensive care, in part because of shortages of ventilators and personal protective equipment.” It was co-authored by Krystina M. Hopkins, Matthew J. Binnicker, and Gregory A. Poland.

Respiratory sampling is a primary way to test for COVID-19 and sampling is often done with a bronchoscope. New recommendations from the American Association for Bronchology and Interventional Pulmonology (AABIP) state physicians should use nasopharyngeal and oropharyngeal swabs when testing for COVID-19. If a bronchoscope must be used in diagnosis or treatment of a suspected or confirmed case, AABIP said, the device should be disposable.

Similarly, Ofstead and her co-authors advocate for single-use bronchoscopes – but if single-use bronchoscopes are not available, she said, it is even more vital that reprocessing guidelines be strictly adhered to and that bronchoscopes used on COVID-19 patients not be mixed in the reprocessing suite with other instruments.

Single-use bronchoscopes are intended to use once and discard, eliminating the need for reprocessing, maintenance, or repair.

The paper highlights several cases in which pseudo-outbreaks have been caused by contaminated bronchoscopes and recent research suggests “that COVID-19 co-infections are associated with significantly higher mortality rates,” the authors write.

In routine times, there are an estimated 500,000 bronchoscopies performed in the U.S. each year. While the relative risk of device-related cross-contamination is considered low, experts have acknowledged a lack of surveillance or tracing infections back to contaminated bronchoscopes may present a false picture of the true infection rate.

Ofstead, the president and CEO of St. Paul, Minnesota-based Ofstead and Associates, has performed numerous research studies with her team and produced a webinar in March 2020 on the challenges of reprocessing flexible bronchoscopes.

Later this month, Ofstead will offer a short webinar on reprocessing bronchoscopes during the COVID-19 pandemic. The webinar will provide front-line clinicians and personnel with critically important information about risks associated with the use of bronchoscopes among patients infected with the coronavirus.

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